3.6 中央角膜瓣坏死 Hainline等[17]回顾1995—2005年的17 100位接受LASIK的患者,发生严重的中央瓣炎症和坏死者共9只眼,其中6只眼为机械微型角膜刀制瓣,3只眼为飞秒激光制瓣。8只眼经过2个月以上的随访,1位患者矫正视力降低了至少两行,2位患者出现远视漂移。炎症反应典型表现者为术后第1天表现轻微,术后5~10 d达到高峰,术后60 d逐渐消退。6位患者接受了掀开角膜瓣、冲洗基质床的治疗,基质床几乎没有发现炎症表现。中央瓣坏死与弥漫性板层炎的区别在于炎症位于瓣的前基质部分,而不是层间。糖皮质激素对中央瓣坏死无明显效果。
3.7 光敏感综合征 Stonecipher等[18]报道术后短暂性光敏感综合征的发生率约1.1%,临床表现为:对光极敏感,但检查可以没有任何异常体征,皮质类固醇激素可以缓解或治愈,但用药时间可能需要持续数月。降低脉冲能量可能减少发生率。
3.8 黄斑出血 尽管飞秒激光制瓣时所使用的吸引环负压(约35 mmHg)明显低于微型角膜刀制作角膜瓣时的负压(约65 mmHg),仍然有黄斑出血的可能,且可出现于原来没有黄斑病理基础的正常人。Principe等[19]报道了1例36岁的女性中度近视病人接受飞秒激光LASIK手术后出现黄斑部出血。术前眼底荧光血管造影已排除存在黄斑部新生血管或其他病变。该病人手术后第1天最佳矫正视力仅20/40,手术后2个月黄斑部变清晰,6个月后视力达到20/25。发生黄斑出血的原因可能与手术时使用负压时间较长及眼压波动有关。
综上所述,尽管飞秒激光较之机械微型角膜刀制瓣安全性、准确性有了很大提高,但是仍然要注意术中、术后并发症的观察和处理。只有这样,才能真正提高手术质量,最大限度体现手术效果。
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